COVID-19 Vaccination of Individuals Aged 65 Years and Over in France: Clinical and Economic Impact of Vaccine Choice

OBJECTIVES: In France, mRNA vaccines against COVID-19 are preferentially recommended for those at highest risk of severe illness from COVID-19, including those aged ≥65 years. The elderly population accounted for 63% of COVID-19 cases admitted to intensive care during the autumn 2023 season while the vaccination coverage (VCR) was estimated at 30.2%. A recent systematic review and meta-analysis found that the mRNA-1273 vaccine was more effective than the BNT162b2 vaccine in ≥65 years individuals (RR infections 0.74, hospitalization 0.69). The study aims to model and compare the impact of COVID-19 vaccination for ≥65 years individuals with mRNA1273 versus BNT162b2 during the autumn 2023 campaign.

METHODS: A dynamic transmission model with an infection consequences decision tree was used to estimate the clinical and economic outcomes of mRNA-1273 vaccination for the French population aged ≥65 years in autumn 2023, considering a 30.2% VCR and a one-year time horizon. The model takes into account residual protection from previous vaccination, natural infection, and predicted effectiveness of the autumn 2023 vaccine. French data were used to estimate costs and health outcomes, where available.

RESULTS: Compared to the BNT162b2 vaccine, vaccination targeting those aged ≥65 years with the mRNA-1273 vaccine during the autumn 2023 campaign would have prevented an additional 2,660 hospitalizations, 3,810 cases of long COVID, and 400 deaths, corresponding to 3,372 QALYs gained. This translates into €23 million in saved direct COVID-19 treatment costs for the French healthcare system. For a BNT162b2 vaccine program to achieve the same COVID-19 treatment costs as with mRNA1273, an absolute 14 points increase in VCR would be needed. Sensitivity analyses confirmed the robustness of these results.

CONCLUSIONS: Vaccinating the French ≥65 years population with the mRNA-1273 vaccine in autumn 2023 would have prevented more hospitalizations and deaths related to COVID-19 compared to vaccination with the BNT162b2 vaccine.